It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board

  • Increase in dosage after 7-8 years on same dose - too soon??

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 09-14-2015, 05:45 AM   #1
    Sparkgap
    Newbie
    (male)
     
    Sparkgap's Avatar
     
    Join Date: Sep 2015
    Posts: 8
    Sparkgap HB User
    Question Increase in dosage after 7-8 years on same dose - too soon??

    After a long time taking the same doseages of the same meds, there seems to be much less effect in the treatment of the severe pain


    If a patient is on the same medications and dosage for 7-8 years and has a couple additional ailments that have developed over that time span (both ailments are surgery worthy & EXTREMELY painful during acute periods - they rate as close to a 10 as possible w/o blacking out) leading to the break-through meds being almost ineffective, would it be acceptable to pursue either an increase in those meds or possibly a different medication for BT management? Is there any "preferred" way to approach the physician about this issue?

     
    The following user gives a hug of support to Sparkgap:
    momzworkin (09-14-2015)
    Sponsors Lightbulb
       
    Old 09-14-2015, 07:55 AM   #2
    momzworkin
    Senior Veteran
    (female)
     
    Join Date: Jun 2006
    Location: Kansas City, Kansas
    Posts: 843
    momzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB User
    Re: Increase in dosage after 7-8 years on same dose - too soon??

    Wow, you asked the same question I came here to ask today. The only difference is I have asked the nurse practitioner in the practice that I see and each time it has been mentioned in the last 5 years she immediately shuts me down. I really like her-I think she is just trying to stay within protocol of the practice.
    But, my poor husband, who watches me deal with this pain, is ready to put his foot down.and wants me to call and get an appointment with the actual doctor I saw the first year I was with the practice. Once you are stable he passes you off to one of his 4 NPs. All she does is ask me to stand up, feels my back where the pain is, asks me to put out my leg (with the knee with osteoarthritis) and that is it. She writes the prescriptions and says "see you back in 2 months!"
    My husband said he will go with me to an appointment with the doctor, but he doesn't understand being afraid to be released without knowing for sure I have found another doctor. Even FINDING another doctor will be a nightmare.

    I am awaiting anyone's advice and experience.
    __________________
    07/2006: A/P fusion L4-S1; DX DDD
    09/2009: started PM
    04/2011: Right rotator cuff tear
    09/2011: re-tore shoulder in PT- lost 30% function in shoulder
    06/2013: diagnosed with failure of L2-L3-L4

     
    Old 09-14-2015, 10:46 AM   #3
    backhurtz
    Senior Veteran
    (female)
     
    backhurtz's Avatar
     
    Join Date: Oct 2008
    Location: NY, USA
    Posts: 818
    backhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB User
    Re: Increase in dosage after 7-8 years on same dose - too soon??

    If you are using breakthrough meds with any regularity, they will inevitably become ineffective.
    Breakthrough meds are only meant to be used for episodes of moderately severe breakthrough pain, and not on a regular basis. Taking them in a regular manner only serves to increase the amount of opiates that your body will quickly become adjusted to having in your system.
    Most pm doctors would not increase the breakthrough meds, but would increase an extended release medication instead to see if that helped.

     
    Old 09-14-2015, 07:00 PM   #4
    tortoisegirl
    Senior Veteran
    (female)
     
    Join Date: Mar 2012
    Location: Washington
    Posts: 1,204
    tortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB User
    Re: Increase in dosage after 7-8 years on same dose - too soon??

    I think the first step is to see your doctor/PA/NP/whatever and explain the increased pain, how long it has been going on, how much relief you are getting now from your untreated pain levels vs. what relief you got at best with the meds (both in X/10 and percentage, what activities you can and cannot do, etc.

    If they are ignoring you on multiple occasions and taking a very long term wait & see approach without changing anything (it doesn't have to be an opioid increase, but they should listen & respond with an action plan), then you need to insist on moving up the chain at the practice if you aren't seeing a doctor, or start looking for another doctor.

    I understand that especially nowadays they have dose ceilings, but at a minimum they can try ad adjunct therapy, switch your long acting and/or breakthrough med to something you might have less tolerance to, evaluate for any worsening condition or another condition that may have developed, or best case, all of the above. If your perceived pain levels are worsening, you are no longer stable, and something should be done. Your doctor may say they can't do anything else, but very very likely they are wrong, and something could be done.

    If they say there is no room to raise your dose, then specifically ask about adding in another treatment (medication or otherwise), switching the medication/s, etc. I understand we are at the mercy of our doctors to continue getting pain meds, but them ignoring our pain and trying nothing different at all is ridiculous. I see a big difference between expecting a response to complaints of increased pain and specifically requesting a higher opioid dose (the former is ok and the later isn't).

    Agreed that it is typically agreed upon that proper use of breakthrough meds is on a truly as needed. Unfortunately lots of doctors don't tell their patients that / prescribe it multiple times a day. If our pain levels are creeping up and our doctors are ignoring us, it is easy to get caught up in taking "too many" (and almost impossible to move away from, especially when the pain is already out of control). For everyone whose pain is at least semi under control though, it is a very good thing to remember. I find my breakthrough med doesn't work well at all if I take it even more than a few times a week.

    If pain levels aren't being adequately treated the majority of the time (often considered 50% relief), then typically a raise in long acting med should be considered (among other things). Typically only if the baseline pain is being treated adequately, the breakthrough med is being used appropriately and the breakthrough med isn't treating the breakthrough pain (bringing it down to or close to baseline treated level) would that dose be raised.

    I recently had my breakthrough pain dose raised as although my long acting med and treatments are working very well, I was getting infrequent episodes of severe acute pain that weren't responding to the previous dose. Even with a 50% increase in breakthrough dose I find I am taking less mg of it per month, as I get my pain levels down much quicker (vs. basically riding them out as I was doing before as the med wasn't working even when used sporadically). Best wishes.
    __________________
    Kate
    constant headache since 2006

     
    Old 09-15-2015, 09:33 PM   #5
    BB07
    Senior Veteran
    (female)
     
    BB07's Avatar
     
    Join Date: Feb 2010
    Location: Lower Alabama
    Posts: 1,102
    BB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB User
    Re: Increase in dosage after 7-8 years on same dose - too soon??

    Make an apt with the doctor-you must communicate your concerns right away. The NP is obviously not in a position to re-evaluate your issues.

    If you are truly deadlocked, you seriously should consult another specialist.

    I recommend you look up Dr Forest Tenant(sp)-he is an amazing physician, and every PM patient should know of him-he has truly brought pm treatment to light.

    My doctor reminds me of him-

    This is a great resource for all pm patients.

    Good luck.
    __________________
    constant companion pain

     
    Old 10-28-2015, 08:01 PM   #6
    jsnaplesfl
    Newbie
    (female)
     
    jsnaplesfl's Avatar
     
    Join Date: Oct 2015
    Location: Naples, FL, USA
    Posts: 1
    jsnaplesfl HB User
    Re: Increase in dosage after 7-8 years on same dose - too soon??

    Quote:
    Originally Posted by momzworkin View Post
    Wow, you asked the same question I came here to ask today. The only difference is I have asked the nurse practitioner in the practice that I see and each time it has been mentioned in the last 5 years she immediately shuts me down. I really like her-I think she is just trying to stay within protocol of the practice.
    But, my poor husband, who watches me deal with this pain, is ready to put his foot down.and wants me to call and get an appointment with the actual doctor I saw the first year I was with the practice. Once you are stable he passes you off to one of his 4 NPs. All she does is ask me to stand up, feels my back where the pain is, asks me to put out my leg (with the knee with osteoarthritis) and that is it. She writes the prescriptions and says "see you back in 2 months!"
    My husband said he will go with me to an appointment with the doctor, but he doesn't understand being afraid to be released without knowing for sure I have found another doctor. Even FINDING another doctor will be a nightmare.

    I am awaiting anyone's advice and experience.
    (1) Your diagnosed DDD has very likely gotten worse - Degenerative Disk Disease gets worse, not better with age.
    (2) Your L2-L3 problem also gets worse with age, not better.

    You have at least two conditions which have worsened over 7-8 years. Tell your doctor about your increased pain and request a new MRI to see how your condition has progressed since your last MRI. The NP/assistant can't deny your request for a new MRI - you will see the doctor. Request an appropriate increase in your medication to match the increase in your pain.

    Medical personnel remain under-educated in pain control and some are still taught all pain patients are drug addicts! A person who has increased pain after 7-8 years of stable unchanged dosage of pain medication has had a noticeable worsening of the degenerating condition. More medication is now required to ease the increased pain.

    [Ouch! I too have a torn R rotator cuff. I looks like an accordion on my MRI.]

     
    Closed Thread




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 07:56 PM.





    © 2020 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!